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DBPR ABT-6023 Division of Alcoholic Beverages and Tobacco Special License Inspection Form

All AB&T applicants for both restaurant and lodging establishments must complete only the applicant

information portion of this form and submit it to the Division of Hotels and Restaurants. A copy of the

sketch of your premises must also be submitted to the Division of Hotels and Restaurants with this form.

If the sketch is drawn on a separate sheet of paper, a copy of the sketch page of the application must

also be submitted.

Zoning Approval

Zoning approval is executed by the city or county zoning authority in which the business to be licensed is

located. Zoning approval is required on all applications that include a change of the licensed location

unless the applicant is a state college or university located on State owned property. Zoning approval

may also be required for certain change or increase in series applications.

Department of Revenue Clearance

Department of Revenue clearance is required on applications for all transfer, change of location, and

correction of information applications which change the licensee’s name.

Affidavit of Applicant

Read and sign in the presence of a notary. The affidavit must be signed by the individual applicant, all

partners of a general partnership, all general partners of a limited partnership, all managing members of a

limited liability company, or one of the officers of a corporate applicant.

Affidavit of Transferor

The affidavit of transferor must be completed for all transfer applications. The affidavit must be signed by

the individual owner, all partners of a general partnership, all general partners of a limited partnership, all

managing members of a limited liability company, or a corporate officer of record. If the transfer is

pursuant to operation of law or judicial proceedings, certified copies of court order(s) in which the

applicant is named may be accepted in lieu of signature(s) of seller.

Fingerprints

Fingerprints must be submitted by all individual applicants, partners, corporate officers, managing

members, stockholders owning .5 or more percent of stock, directors, and all general partners of a limited

partnership. Fingerprints must be taken by a law enforcement agency and must be taken on fingerprint

cards provided by the district office serving your area. You must submit the DBPR ABT-6021 Fingerprint

Affidavit form with the fingerprint card, plus a $47 processing fee.

Note: If you are a current licensee or have been fingerprinted by this division in the past three (3) years,

you are not required to submit this fingerprint information or fees.

Partner, Officer, Stockholder Personal Data - Section 4

This section of the application must be completed with original signatures for each applicant or person(s)

directly connected with the business, unless they are current licensees. This will include the sole

proprietor, all partners, officers, directors, individual share holders owning more than .5% of stock in non-

public corporations, general partners of general partnerships, general partners of a limited partnership,

and the managing partners of a limited liability company. Directly interested persons include anyone that

is connected with the business who has a beneficial interest. It is important that each individual disclose

any arrests they have had, even if they were charged, but not formally arrested, and regardless of the

disposition.

Social Security Number

Under the Federal Privacy Act, disclosure of Social Security numbers is voluntary unless a Federal

statute specifically requires it or allows states to collect the number. In this instance, disclosure of social

security numbers is mandatory pursuant to Title 42 United States Code, Sections 653 and 654; and

sections 409.2577, 409.2598, and 559.79, Florida Statutes. Social Security numbers are used to allow

efficient screening of applicants and licensees by a Title IV-D child support agency to assure compliance

with child support obligations. Social Security numbers must also be recorded on all professional and

occupational license applications and are used for licensee identification pursuant to the Personal

Instructions For Completing Dbpr Abt - 6035 Form - Division Of Alcoholic Beverages And Tobacco Page 2

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